Opinion: There are various hangovers from being Chair of Te Whatu Ora. Many of these are responding to ongoing concerns about bad practices from within the health system – from patients, staff, and whānau – running at a dozen a week.

I try to listen to, respond, explain or even promote those concerns because I care about them. Some of it is heartbreaking. Especially where fear of speaking out is so evident. There is clear evidence, which the staff survey has confirmed, of a culture within the system which is an obstacle to reaching Pae Ora/Healthy Futures.

The process of promoting the Health Charter is nearing fruition within the system. There is hope around this document setting out how the people in the system want to work together in all aspects. It has some good words and most would like to think it reflected reality. There is some cynicism about it, and it will certainly fail if it is not consistent with actual behaviour. Implementing it will be a much bigger challenge than writing it, but cynicism will not help.

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I am aware being dominated by negative concerns is not healthy for me or those still working within the system, they have vital jobs to do. Like them, I want to see a healthy public health system. I do not want to be like my old nemesis Rob Muldoon who, after being shafted by his colleagues, was asked if he would continue being a thorn in their side and memorably responded, “No, more like a little prick”.

Fortunately much of what I do see among those delivering our health services is joyful and positive. Especially, but not exclusively, in the “primary sector”. To touch on interactions in the past week:

I had a very pleasant and informative visit with staff in a low-decile general practice where the leader generously took aside some time to walk me through how they were handling various demands and complications. All with firm, caring intent and hope. Thanks, Papatoetoe Family Doctors.

Papatoetoe is a strikingly multi-ethnic community and one could get overwhelmed by difficulties in reaching and serving. But from locating as a shop front in a retail district, using their own and national tele-health systems and careful presentation, this standalone general practice meets community needs. Innovation is part of the good general practice service, and there are many of them embedded in the community.

There is so much positive happening across the country from sisters and brothers doing it for themselves and their communities. Te Pae Tata, the health plan, and the various organisational reforms associated with it, really have to just recognise, honour and nurture what is there in the community

Then at the BBM Manukau From the Couch Obesity program, a team from Total Healthcare was delivering a health check and even new on-the-spot blood-testing to participants – another practical on-the-ground-innovation serving a population which might otherwise be seen as “hard to reach”. At the same session doctor and author David Beaumont talking about his “positive medicine” approach with the same group. Opening eyes to ways of thinking about personal health beyond the clinic or surgery.

Talking through with another major primary health organisation (ProCare) – in a café this time, dodging the cakes – their many initiatives to improve their community health services and contribution to the work of Te Whatu Ora and Te Aka Whai Ora.

A similar meeting with National Hauora Coalition on their PHO work reaching out from Māori providers to a wider range of services. And similarly my interactions with Silao Vaisola-Sefo at South Seas and his team and their work leading the Otara “locality” alongside their existing services. These are a level up from “the ground” but each driven from there rather than national bureaucratic plans, clear that their responsibility lies with the whānau in their area. They would never say so, but it’s very clear their task is to simply get the best they can out of what the system bosses think they should have.

Most recently meeting with the leadership team at Le Va – a strong Pasifika-led mental health and wellbeing group promoting holistic, clinically led training, resources and support across a wide range. Strongly responding to their survey of Pacific people’s views on health and wellbeing, which established mental health as the dominant concern. Again and in each of these interactions firm, caring intent and hope. It is a very powerful experience to have.

Or learning from Tania Kingi at Te Roopu Waiora that her brave and positive group of disabled (but so powerful) Māori have gained a contract to serve their community and others and build their skills and confidence. They will serve and challenge, and have given me a Matariki wero which has me shaking.

Or learning towards to end of the week of the positive things already flowing from the work of one of the Iwi Māori Partnership Boards and an associated locality where I might have been inclined to focus on the difficulties and limitations being told firmly of the opportunities. Far from mission achieved, or even delivered, but again firm, caring, hope.

Or meeting an innovator with a positive programme of health care and management with a strong technology backing which is starting to roll out. That was all in the past week.

I hope remaining board members are all getting similar amounts of quality of exposure to what is happening.

There is so much positive happening across the country from sisters and brothers doing it for themselves and their communities. Te Pae Tata, the health plan, and the various organisational reforms associated with it, really have to just recognise, honour and nurture what is there in the community.

I do worry, looking back at my own involvement, and looking from the outside at what is happening now, that too much emphasis has been placed on what is wrong and on the ability of management from above to make change, and too little attention is paid to the positive work that is there across the “primary health” sector that did not need reform, just responsive funding and support which existing structures might have been simply amended to deliver.

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